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Punjab-Haryana High Court
Suman Gupta vs The Permanent Lok Adalat ( Public ... on 13 March, 2026
CWP-1595-2026 (O&M) -1-
IN THE HIGH COURT OF PUNJAB AND HARYANA
AT CHANDIGARH
111 CWP-1595-2026 (O&M)
Date of Decision: 13.03.2026
Suman Gupta ...Petitioner
Versus
The Permanent Lok Adalat (Public Utility Services) Bhiwani and
another ...Respondents
CORAM: HON'BLE MR. JUSTICE JAGMOHAN BANSAL
Present: - Mr. Kamal Sharma, Advocate
for Mr. Amit Arora, Advocate for the petitioner
Mr. Nitin Thatai, Advocate,
Ms. Monika Thatai, Advocate,
Ms. Shruti Sharma, Advocate and
Mr. Karan Sharma, Advocate for respondent No.2
***
JAGMOHAN BANSAL, J. (Oral)
1. The petitioner through instant petition under Articles 226/227
of the Constitution of India is seeking setting aside of order dated
19.08.2025 whereby her insurance claim has been rejected by learned
Permanent Lok Adalat ('PLA').
2. The petitioner's husband obtained life insurance policy from
Birla Sun Life Insurance Company Limited. The policy was issued on
27.09.2017 and insured passed away on 28.12.2017 i.e. within three months
from the date of policy. The sum insured was ₹5,53,000/- and annual
premium was Rs.49,311/-. The respondent repudiated petitioner's claim vide
letter dated 31.03.2018, thus, she approached learned PLA. Both sides led
their evidence and learned PLA vide impugned order dated 19.08.2025
rejected petitioner's claim on the ground that there was concealment of facts
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CWP-1595-2026 (O&M) -2-
on the part of insured. He was a known case of CVA (acute infract in
periventricular region with right ICA thrombosis) with type 2 diabetes
mellitus with coronary artery disease (post CABG) 4 years back. The
insured in the application form answered 'No' with respect to medical
history.
3. Learned counsel for the petitioner submits that petitioner was
unaware of disease which was noticed by Maharaja Agrasen Hospital in its
report dated 27.12.2017. As insured was not aware of disease pointed out by
aforesaid hospital, there was no occasion for him to disclose or conceal the
disease.
4. Heard the arguments and perused the record.
5. Learned PLA by impugned order has rejected petitioner's claim
on the ground that there was concealment of material facts. The findings
recorded by learned PLA read as:
"7. When the petition was posted for recording the
evidence of the petitioner, Learned Counsel for the petitioner
has tendered documents Ex.P-1 to Ex.P-9 and closed the
evidence.
8. Contrary to it, Learned Counsel for the respondent has
placed on file Affidavit Ex.RW1/A alongwith documents Ex.R-
1 to Ex.R-9 and closed the evidence.
9. Arguments have been heard in detail. Entire records
has also been properly perused and examined. Similarly,
whatever the documentary evidence has been lead during the
proceedings of the petition, has also been appreciated.
10. Repudiation Letter Dated 31.03.2018 Ex.P-1 shows
that claim filed by the petitioner was repudiated, interalia, by
making following observation:-
"As per the "Claimant's Statement" and "Death
Certificate" Life Assured expired in 3 months & 1 days
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since policy issuance date i.e; on December 28, 2017
due to Cardiac Arrest.
In the said proposal, the Life Assured, in replies to Q
Nos. 14 II, IV (a) (1) had replied in the negative. For
your reference, we are reproducing below the
aforesaid questions and the replies thereto in the
proposal for insurance:
14) MEDICAL HISTORY
II. In the past five years, have you ever undergone
any surgical operation at a hospital or clinic or
undergone any investigations with other than normal
or negative results (including X-rays, ECG. blood
tests, biopsies etc.?..................... NO
IV. Have you ever sought advice or suffered from
any of the following?
a) Chest pain, low or high blood pressure, high
cholesterol, heart attack, heart murmur or other heart
disorder?.................................No
1) Any other illness, surgery or
injury?............................. No
Similarly, in his statement to the Medical Examiner in
the Medical Examiner's Report dated September 23,
2017 submitted as part of his application for
insurances, the Life Assured had replied in negative to
questions numbered Part 1 4 (a) (k) of the Medical
Examiner's Report (the "MER"). For your reference,
we are reproducing below the aforesaid questions and
the replies thereto in the MER:
Part I
4. Have you ever had or sought advice for:
a) Chest pain, high blood pressure, stroke, heart
attack, heart murmur or other heart
disorder?............................... NO
k) Any other illness, surgery or
Injury?.............................NO
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However, our investigation findings have established
that the Life Assured was suffering from Coronary
Artery Disease and had undergone Coronary Artery
Bypass Grafting for the same prior to application for
the insurance. Hence, we are satisfied that the
aforesaid replies in the Proposal (for insurance and
MER are false".
11. Perusal of Common Application Form Ex.R-1 shows
that LA has replied the questions, as pointed out above, in
"No".
12. Insurance Company has filed the Death Claim
Investigation Report Ex.R-1 wherein the Death Summary
Dated 28.12.2017 issued by Maharaja Agrasen Hospital is
attached. Aforesaid Death Summary shows that doctor has
made following observations:-
The patient was admitted with complaints of mouth
deviation towards right side on 26.11.2017, slurring of
speech and weakness of left side of body. The patient
was a known case of CVA (acute infract in
periventricular region with right ICA thrombosis) with
type 2 diabetes mellitus with coronary artery disease
post CABG) 4 years back".
13. From the perusal of Death Summary given by Dr.
Suresh Mittal and Dr. R.S. Raman, Senior Consultants, Life
Assured Suresh Kumar was a known case of CVA (acute
infract in periventricular region with right ICA thrombosis)
and was having Coronary Artery Disease (Post CABG 4
years back).
14. However, as stated above, the LA has not disclosed the
aforesaid disease in the Proposal Form despite specific
questions to him. Therefore, having coronary disease and not
disclosing in the Proposal Form at the time of seeking
medical insurance cover amounts to clear concealment of
material facts having bearing on admissibility of medical
health policy. So, when there is a material concealment of
fact, Insurance Company has every right to repudiate the
claim.
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15. In the case in hand, respondent Insurance Company
has repudiated the claim of the petitioner while taking into
consideration the fact that LA was suffering from Coronary
Artery Disease and Undergone Coronary Artery Bypass
Grafting. Therefore, no fault can be found with the
repudiation of the claim by the Insurance Company on the
aforesaid grounds."
6. From the perusal of above quoted findings, it is evident that
insured was suffering from ailment, however, he did not disclose the same in
the application form despite specific question. As he was guilty of
concealment of facts, the insurer was within its jurisdiction to repudiate the
claim. It is apposite to notice that insured passed away within three months
from the date of issuance of insurance policy. There is no manifest factual or
legal infirmity in the impugned order warranting interfere of this Court.
7. In the wake of above discussion and findings, this Court is of
the considered opinion that present petition deserves to be dismissed and
accordingly dismissed.
8. Pending application(s), if any, shall stand disposed of.
(JAGMOHAN BANSAL)
JUDGE
13.03.2026
Mohit Kumar
Whether speaking/reasoned Yes/No
Whether reportable Yes/No
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